tbuckley/cabot-search huggingface dataset:
Association of Health-Related Social Needs With Quality and Utilization Outcomes in a Medicare Advantage Population With Diabetes
Authors: Jessica L. Ryan, Stephanie M. Franklin, Melanie Canterberry, Charron L. Long, Andy Bowe, Brandy D. Roy, Danielle Hessler, Benjamin Aceves, Laura M. Gottlieb
Journal: JAMA Network Open (2023)

Importance Recent research highlights the association of social determinants of health with health outcomes of patients with type 2 diabetes (T2D). Objective To examine associations between health-related social needs (HRSNs) and health care quality and utilization outcomes in a Medicare Advantage population with T2D. Design, Setting, and Participants This cross-sectional study used medical and pharmacy claims data from 2019. An HRSN survey was given between October 16, 2019, and February 29, 2020, to Medicare Advantage beneficiaries. Inclusion criteria were diagnosis of T2D, age of 20 to 89 years, continuous Medicare Advantage enrollment in 2019, and response to the HRSN survey. Data were analyzed between June 2021 and January 2022. Exposures Enrollment in Medicare Advantage, diagnosis of T2D, and completion of a survey on HRSNs. Main Outcomes and Measures Quality outcomes included diabetes medication adherence, statin adherence, completion of a glycated hemoglobin (HbA 1c ) laboratory test in the past 12 months, and controlled HbA 1c . Utilization outcomes included all-cause hospitalization, potentially avoidable hospitalization, emergency department discharge, and readmission. Results Of the 21 528 Medicare Advantage beneficiaries with T2D included in the study (mean [SD] age, 71.0 [8.3] years; 55.4% women), most (56.9%) had at least 1 HRSN. Among the population with T2D reporting HRSNs, the most prevalent were financial strain (73.6%), food insecurity (47.5%), and poor housing quality (39.1%). In adjusted models, loneliness (odds ratio [OR], 0.85; 95% CI, 0.73-0.99), lack of transportation (OR, 0.80; 95% CI, 0.69-0.92), utility insecurity (OR, 0.86; 95% CI, 0.76-0.98), and housing insecurity (OR, 0.78; 95% CI, 0.67-0.91) were each associated with lower diabetes medication adherence. Loneliness and lack of transportation were associated with increased emergency visits (marginal effects of 173.0 [95% CI, 74.2-271.9] and 244.6 [95% CI, 150.4-338.9] emergency visits per 1000 beneficiaries for loneliness and transportation, respectively). Food insecurity was the HRSN most consistently associated with higher acute care utilization (marginal effects of 84.6 [95% CI, 19.8-149.4] emergency visits, 30.4 [95% CI, 9.5-51.3] inpatient encounters, and 17.1 [95% CI, 4.7-29.5] avoidable hospitalizations per 1000 beneficiaries). Conclusions and Relevance In this cross-sectional study of Medicare Advantage beneficiaries with T2D, some HRSNs were associated with care quality and utilization. The results of the study may be used to direct interventions to the social needs most associated with T2D health outcomes and inform policy decisions at the insurance plan and community level.
Efficacy and Safety of Esketamine for Supplemental Analgesia During Elective Cesarean Delivery
Authors: Li-Li Xu, Chun Wang, Chun-Mei Deng, Shao-Bing Dai, Qun Zhou, Yong-Bao Peng, Hong-Yan Shou, Yin-Qiu Han, Jing Yu, Chao-Hui Liu, Feng Xia, Su-Qin Zhang, Dong-Xin Wang, Xin-Zhong Chen
Journal: JAMA Network Open (2023)

Importance Epidural anesthesia is a primary choice for cesarean delivery, but supplemental analgesics are often required to relieve pain during uterine traction. Objective To investigate the sedative and analgesic effects of intravenous esketamine administered before childbirth via cesarean delivery with the patient under epidural anesthesia. Design, Setting, and Participants This multicenter, double-blind randomized clinical trial assessed 903 women 18 years or older who had full-term single pregnancy and were scheduled for elective cesarean delivery with epidural anesthesia in 5 medical centers in China from September 18, 2021, to September 20, 2022. Intervention Patients were randomized to receive intravenous injection of 0.25 mg/kg of esketamine or placebo before incision. Main Outcomes and Measures The coprimary outcomes included scores on the numeric rating scale of pain (an 11-point scale, with 0 indicating no pain and 10 indicating the worst pain; a difference of ≥1.65 points was clinically meaningful) and Ramsay Sedation Scale (a 6-point scale, with 1 indicating restlessness and 6 indicating deep sleep without response; a difference of ≥2 points was clinically meaningful) immediately after fetal delivery. Secondary outcomes included neonatal Apgar score assessed at 1 and 5 minutes after birth. Results A total of 600 women (mean [SD] age, 30.7 [4.3] years) were enrolled and randomized; all were included in the intention-to-treat analysis. Immediately after fetal delivery, the score on the numeric rating scale of pain was lower with esketamine (median [IQR], 0 [0-1]) than with placebo (median [IQR], 0 [0-2]; median difference, 0; 95% CI, 0-0; P = .001), but the difference was not clinically important. The Ramsay Sedation Scale scores were higher (sedation deeper) with esketamine (median [IQR], 4 [3-4]) than with placebo (median [IQR], 2 [2-2]; median difference, 2; 95% CI, 2-2; P &amp;amp;lt; .001). The neonatal Apgar scores did not differ between the 2 groups at 1 minute (median difference, 0; 95% CI, 0-0; P = .98) and at 5 minutes (median difference, 0; 95% CI, 0-0; P = .27). Transient neurologic or mental symptoms were more common in patients given esketamine (97.7% [293 of 300]) than in those given placebo (4.7% [14 of 300]; P &amp;amp;lt; .001). Conclusions and Relevance For women undergoing cesarean delivery under epidural anesthesia, a subanesthetic dose of esketamine administered before incision produced transient analgesia and sedation but did not induce significant neonatal depression. Mental symptoms and nystagmus were common but transient. Indications and the optimal dose of esketamine in this patient population need further clarification, but study should be limited to those who require supplemental analgesia. Trial Registration ClinicalTrials.gov Identifier: NCT04548973
Association of Overweight, Obesity, and Recent Weight Loss With Colorectal Cancer Risk
Authors: Marko Mandic, Fatemeh Safizadeh, Tobias Niedermaier, Michael Hoffmeister, Hermann Brenner
Journal: JAMA Network Open (2023)

Importance Overweight and obesity, conditions with rising prevalence in many countries, are associated with increased colorectal cancer (CRC) risk. However, many patients with CRC lose weight before diagnosis, which may lead the association to be underestimated. Objective To evaluate the association of body mass index (BMI) and weight change with CRC risk when considering BMI at different time frames, with the intention to account for prediagnostic weight loss. Design, Setting, and Participants This population-based case-control study was conducted in southwestern Germany between 2003 and 2021. Cases with a first diagnosis of CRC and controls (frequency matched by age, sex, and county) with comprehensive risk factor information and self-reported weight at different time points were included. Data were analyzed between October 2022 and March 2023. Exposure BMI and weight change at different time frames before the time of diagnosis (cases) or recruitment (controls). Main Outcomes and Measures Association of BMI and weight change at various points in time before and up to diagnosis with CRC, assessed by multivariable logistic regression with comprehensive confounder adjustment. Results A total of 11 887 participants (6434 CRC cases, 5453 controls; median [IQR] age, 69 [61-77] years; 7173 male [60.3%]) were included. At the time of diagnosis, 3998 cases (62.1%) and 3601 controls (66.0%) were overweight or obese, suggesting an inverse association between excess weight and CRC risk. Conversely, we found significant positive associations of overweight (adjusted odds ratio [aOR], 1.27; 95% CI, 1.03-1.56), obesity (aOR, 2.09; 95% CI, 1.61-2.70), and a 5-unit increase in BMI (aOR, 1.35; 95% CI, 1.21-1.50) with CRC risk when using BMI measured 8 to 10 years before diagnosis. High BMI as a risk factor for CRC was increased as earlier periods before diagnosis were examined, with the association being particularly pronounced using BMI at least 8 years before diagnosis. An opposite trend was found for the association of weight loss (at or exceeding 2 kg) with CRC, with the greatest effect sizes occurring for weight loss within 2 years before diagnosis (aOR, 7.52; 95% CI, 5.61-10.09), and gradually decreased for earlier intervals. Conclusions and Relevance In this population-based case-control study, accounting for substantial prediagnostic weight loss further highlighted the association of overweight and obesity with CRC risk.
Trends in Prevalence of Gout Among US Asian Adults, 2011-2018
Authors: Chio Yokose, Natalie McCormick, Na Lu, Sruthi Tanikella, Kehuan Lin, Amit D. Joshi, Laura M. Raffield, Erica Warner, Tony Merriman, John Hsu, Kenneth Saag, Yuqing Zhang, Hyon K. Choi
Journal: JAMA Network Open (2023)

Gout disparities among Black individuals in the US have recently been explained by socioclinical factors; however, no information is available among Asian individuals living in Western countries, despite their disproportionately worsening metabolic health.
New Onset of Tuberculosis Complicating FDG PET/CT Evaluation in Patient With Recent Chimeric Antigen Receptor T-Cell Therapy
Authors: Guanyun Wang, Xu Yang, Hongrong Wang, Wei Wang, Jigang Yang
Journal: Clinical Nuclear Medicine (2023)

Abstract A 16-year-old adolescent girl with CD19 chimeric antigen receptor (CAR) T-cell therapy for acute lymphoblastic leukemia experienced new onset of the fever. 18 F-FDG PET/CT studies acquired at 1 and 2 months, respectively, after CAR-T, showed foci of abnormal activity in the mediastinal lymph nodes not seen on the study before therapy. However, these foci of abnormal activity were later proven due to newly developed tuberculosis after CAR T-cell therapy.
Addressing Health-Related Social Needs in the Clinical, Community, and Policy Domains
Authors: Anders Chen, Kendrick Gwynn, Stacie Schmidt
Journal: JAMA Network Open (2023)

Jessica L. Ryan, PhD; Stephanie M. Franklin, MPS; Melanie Canterberry, PhD; Charron L. Long, PharmD; Andy Bowe, MPH; Brandy D. Roy, MD; Danielle Hessler, PhD; Benjamin Aceves, PhD; Laura M. Gottlieb, MD
Tissue-resident memory T cell maintenance during antigen persistence requires both cognate antigen and interleukin-15
Authors: Roger Tieu, Qiang Zeng, Daqiang Zhao, Gang Zhang, Neda Feizi, Priyanka Manandhar, Amanda L. Williams, Benjamin Popp, Michelle A. Wood-Trageser, Anthony J. Demetris, J. Yun Tso, Aaron J. Johnson, Lawrence P. Kane, Khodor I. Abou-Daya, Warren D. Shlomchik, Martin H. Oberbarnscheidt, Fadi G. Lakkis
Journal: Science Immunology (2023)

Our understanding of tissue-resident memory T (T
FAM129A promotes self-renewal and maintains invasive status via stabilizing the Notch intracellular domain in glioma stem cells
Authors: Guohao Liu, Po Zhang, Sui Chen, Zirong Chen, Yanmei Qiu, Peng Peng, Wenda Huang, Fangling Cheng, Yang Zhang, Huan Li, Qungen Xiao, Feng Mao, Baofeng Wang, Xiaobing Jiang, Feng Wan, Dongsheng Guo, Xingjiang Yu
Journal: Neuro-Oncology (2023)

Glioma stem cells (GSCs) are a subpopulation of tumor cells with self-renewal and tumorigenic capabilities in glioblastomas (GBMs). Diffuse infiltration of GSCs facilitates tumor progression and frustrates efforts at effective treatment. Further compounding this situation is the currently limited understanding of what drives GSC invasion. Here we comprehensively evaluated the significance of a novel invasion-related protein, Family with Sequence Similarity 129 Member A (FAM129A), in infiltrative GSCs.Western blotting, immunohistochemistry, and gene expression analysis were used to quantify FAM129A in glioma specimens and cancer datasets. Overexpression and knockdown of FAM129A in GSCs were used to investigate its effects on tumor growth and invasion. RNA-seq, qRT-PCR, western blotting, and co-precipitation assays were used to investigate FAM129A signaling mechanisms.FAM129A is preferentially expressed in invasive frontiers. Targeting FAM129A impairs GSC invasion and self-renewal. Mechanistically, FAM129A acted as a positive regulator of Notch signaling by binding with the Notch1 intracellular domain (NICD1) and preventing its degradation.FAM129A and NICD1 provide a precise indicator for identifying tumor margins and aiding prognosis. Targeting them may provide a significantly therapeutic strategy for GSCs.
RNA‐Cleaving DNAzyme‐Based Amplification Strategies for Biosensing and Therapy
Authors: Jiaxin Su, Chenyang Sun, Jinya Du, Xiaotong Xing, Fang Wang, Haifeng Dong
Journal: Advanced Healthcare Materials (2023)

Since their first discovery in 1994, DNAzymes have been extensively applied in biosensing and therapy that act as recognition elements and signal generators with the outstanding properties of good stability, simple synthesis, and high sensitivity. One subset, RNA-cleaving DNAzymes, is widely employed for diverse applications, including as reporters capable of transmitting detectable signals. In this review, the recent advances of RNA-cleaving DNAzyme-based amplification strategies in scaled-up biosensing are focused, the application in diagnosis and disease treatment are also discussed. Two major types of RNA-cleaving DNAzyme-based amplification strategies are highlighted, namely direct response amplification strategies and combinational response amplification strategies. The direct response amplification strategies refer to those based on novel designed single-stranded DNAzyme, and the combinational response amplification strategies mainly include two-part assembled DNAzyme, cascade reactions, CHA/HCR/RCA, DNA walker, CRISPR-Cas12a and aptamer. Finally, the current status of DNAzymes, the challenges, and the prospects of DNAzyme-based biosensors are presented.
Primary Neuroblastoma of the Thymus
Authors: Kailash Chaurasiya, Elena Kireeva, Tatyana Shamanskaya, Denis Kachanov, Yury Likar
Journal: Clinical Nuclear Medicine (2023)

Primary neuroblastoma is the most common extracranial solid tumor in children and may occur anywhere along the sympathetic chain, but most commonly occur in abdominal/retroperitoneal region including the adrenal glands, followed by the thorax. In children, the most primary neuroblastomas in the thorax are in the posterior mediastinum. We present herein an extremely rare case of primary neuroblastoma of thymus in pediatric patient.
Slowly Expanding 18F-FDG PET-Positive Irregular Opacities in the Lung Due to Diffuse Lymphoid Hyperplasia Preceding Rheumatoid Arthritis
Authors: Kenya Sumitomo, Taku Okamoto, Kaoru Arii, Manabu Matumoto, Tsutomu Shinohara
Journal: Clinical Nuclear Medicine (2023)

Pulmonary diffuse lymphoid hyperplasia (DLH), a nonneoplastic lymphoproliferative disorder (LPD), is extremely rare, and no PET/CT findings have been reported for pulmonary DLH. We observed slowly expanding irregular opacities with 18 F-FDG accumulation (SUV max , 3.64) in the right lower lobe of a 51-year-old asymptomatic man. The patient underwent video-assisted thoracoscopic biopsy on suspicion of malignant lesions. Histologically, no neoplastic cells were present, and the lesion was consistent with DLH. Six months later, the patient developed rheumatoid arthritis. DLH should be considered in the differentiation of PET-positive irregular opacities, even in the absence of known immune abnormalities.
Can PSMA-Targeting PET/CT Be a Valuable Instrument to Assess the Presence of Brain Metastases in Lung Cancer Patients?
Authors: Sara Dall'Armellina, Simona Cauda, Sergio Duca, Martina Gasparro, Manuela Racca
Journal: Clinical Nuclear Medicine (2023)

A 78-year-old man with synchronous diagnosis of prostate cancer and lung adenocarcinoma was referred to our institute for prostate cancer staging with [ 18 F]F-prostate-specific membrane antigen (PSMA) 1007 PET/CT. In addition to the previously known lesion of the right lung, PSMA-targeted PET/CT highlighted 2 areas of abnormal uptake in the brain, in the left frontal and temporal lobes. A subsequent MRI confirmed the lesions observed on PET/CT. Because PSMA-targeting radiopharmaceuticals do not accumulate in healthy brain parenchyma, and recent literature reported promising performances of PSMA-targeted PET/CT in gliomas and metastases from tumors other than prostate cancer, this employment of PSMA radioligands needs to be further explored.
Routine Prophylactic Esketamine for the Prevention of Maternal Pain During Cesarean Delivery
Authors: Rachel J. Kearns, Scott M. Nelson
Journal: JAMA Network Open (2023)

Li-Li Xu, MD; Chun Wang, MD; Chun-Mei Deng, MD; Shao-Bing Dai, MD; Qun Zhou, MD; Yong-Bao Peng, MD; Hong-Yan Shou, MD; Yin-Qiu Han, MD; Jing Yu, MD; Chao-Hui Liu, MD; Feng Xia, MD; Su-Qin Zhang, MD; Dong-Xin Wang, MD; Xin-Zhong Chen, MD
Association of Statin Use With Cancer- and Noncancer-Associated Survival Among Patients With Breast Cancer in Asia
Authors: Wei-Ting Chang, Hui-Wen Lin, Sheng-Hsiang Lin, Yi-Heng Li
Journal: JAMA Network Open (2023)

Importance In addition to protective effects on the cardiovascular system, statins may reduce the risk of breast cancer recurrence owing to potential anti-inflammatory benefits. Given that patients with breast cancer in Asia are relatively younger at diagnosis and most are free from traditional cardiovascular risk factors, it is uncertain whether the use of statins can improve survival. Objective To investigate the association of statin use with cancer- and noncancer-associated survival in patients with breast cancer. Design, Setting and Participants This cohort study used the Taiwanese National Health Insurance Research Database and National Cancer Registry to identify patients diagnosed with breast cancer from January 2012 to December 2017. Age, cancer stage, anticancer therapies, comorbidities, socioeconomic status, and cardiovascular drugs were matched by propensity score method. Statistical analyses, including Cox proportional hazards models, were performed from June 2022 to February 2023. The mean (SD) follow-up duration was 4.10 (2.96) years. Interventions Patients receiving statins within 6 months before the diagnosis of breast cancer were compared with those not receiving statins. Main Outcomes and Measures Outcomes included death, heart failure, and arterial and venous events. Results Overall, 7451 patients (mean [SD] age, 64.3 [9.4] years) treated with statins were matched with 7451 nonusers (mean [SD] age, 65.8 [10.8] years). Compared with nonusers, statin users had a significantly lower risk of all-cause death (adjusted hazard ratio [HR], 0.83; 95% CI, 0.77-0.91; P &amp;amp;lt; .001). Notably, the risk reduction was mainly attributed to cancer-related death (adjusted HR, 0.83; 95% CI, 0.75-0.92; P &amp;amp;lt; .001). Only a small number of patients died of cardiovascular causes, and the ratios were similar between statin users and nonusers. No significant differences were observed in cardiovascular outcomes, including heart failure and arterial and venous events, between statin users and nonusers. Using a time-dependent analysis, statin users also presented a significantly lower risk of cancer-related death (adjusted HR, 0.28; 95% CI, 0.24-0.32; P &amp;amp;lt; .001) than nonusers, and notably, the risk was even lower in high-dose statin (HDS) users compared with non-HDS users (HDS users: adjusted HR, 0.84; 95% CI, 0.73-0.98; P = .002; non-HDS users: adjusted HR, 0.79; 95% CI, 0.68-0.91; P = 001). Conclusions and Relevance In this cohort study of Asian patients with breast cancer, statin use was associated with a reduced risk of cancer-associated death rather than cardiovascular death. Our findings provide evidence to support the use of statins in patients with breast cancer; however, randomized studies are necessary.
Ingestion of Illicit Substances by Young Children Before and During the COVID-19 Pandemic
Authors: Brittany J. Raffa, Samantha Schilling, M. Katherine Henry, Victor Ritter, Colleen E. Bennett, Jeannie S. Huang, Natalie Laub
Journal: JAMA Network Open (2023)

Importance Information about the trend in illicit substance ingestions among young children during the pandemic is limited. Objectives To assess immediate and sustained changes in overall illicit substance ingestion rates among children younger than 6 years before and during the COVID-19 pandemic and to examine changes by substance type (amphetamines, benzodiazepines, cannabis, cocaine, ethanol, and opioids) while controlling for differing statewide medicinal and recreational cannabis legalization policies. Design, Setting, and Participants Retrospective cross-sectional study using an interrupted time series at 46 tertiary care children’s hospitals within the Pediatric Health Information System (PHIS). Participants were children younger than 6 years who presented to a PHIS hospital for an illicit substance(s) ingestion between January 1, 2017, and December 31, 2021. Data were analyzed in February 2023. Exposure Absence or presence of the COVID-19 pandemic. Main Outcome(s) and Measure(s) The primary outcome was the monthly rate of encounters for illicit substance ingestions among children younger than 6 years defined by International Statistical Classification of Diseases, Tenth Revision, Clinical Modification diagnosis code(s) for poisoning by amphetamines, benzodiazepines, cannabis, cocaine, ethanol, and opioids. The secondary outcomes were the monthly rate of encounters for individual substances. Results Among 7659 children presenting with ingestions, the mean (SD) age was 2.2 (1.3) years and 5825 (76.0%) were Medicaid insured/self-pay. There was a 25.6% (95% CI, 13.2%-39.4%) immediate increase in overall ingestions at the onset of the pandemic compared with the prepandemic period, which was attributed to cannabis, opioid, and ethanol ingestions. There was a 1.8% (95% CI, 1.1%-2.4%) sustained monthly relative increase compared with prepandemic trends in overall ingestions which was due to opioids. There was no association between medicinal or recreational cannabis legalization and the rate of cannabis ingestion encounters. Conclusions and Relevance In this study of illicit substance ingestions in young children before and during the COVID-19 pandemic, there was an immediate and sustained increase in illicit substance ingestions during the pandemic. Additional studies are needed to contextualize these findings in the setting of pandemic-related stress and to identify interventions to prevent ingestions in face of such stress, such as improved parental mental health and substance treatment services, accessible childcare, and increased substance storage education.
Upstream Strategies, Alternatives to Detention, and System Transformation to Address Interconnected Harms of Youth Detention and Firearm Injuries
Authors: Vivian H. Lyons, Benjamin Danielson
Journal: JAMA Network Open (2023)

Nanzi Zheng, MS; Karen M. Abram, PhD; Leah J. Welty, PhD; David A. Aaby, MS; Nicholas S. Meyerson, MA; Linda A. Teplin, PhD
Long-term Risk of Epilepsy Following Invasive Group B <i>Streptococcus</i> Disease in Neonates in Denmark
Authors: Malene Risager Lykke, Henrik Toft Sørensen, Joy Elisabeth Lawn, Erzsébet Horváth-Puhó
Journal: JAMA Network Open (2023)

The risk of epilepsy after neonatal invasive Group B Streptococcus (iGBS) disease, particularly iGBS sepsis, is poorly understood.